Carbapenem-non-susceptible Enterobacteriaceae in Europe: Conclusions from a meeting of national experts

Hajo Grundmann*, D. M. Livermore, C. G. Giske, R. Canton, Gian Maria Rossolini, J. Campos, Alkis Vatopoulos, Marek Gniadkowski, Akos Toth, Yvonne Pfeifer, Vincent Jarlier, Yehuda Carmeli, Helmut Mittermayer, Mathijs Goossens, Nijaz Tihic, Yuliha Proevska, Arjana Tambic, Despo Pieridou-Bagatzouni, Helena Zemlickova, Jaroslav HrabakAnette M. Hammerum, Marina Ivanova, Jari Jalavi, Hordur Hardarson, Teck Wee Boo, Raul Colodner, Monica Monaco, Aurora Garcia-Fernandez, Arta Balode, Jolanta Miciuleviciene, Paul Caruana, Gunnar Skov, Orjan Samuelsen, Waleria Hryniewicz, Manuela Caniça, Vera Manageiro, Irina Codita, Manica Mueller-Premru, Jana Kolman, Jesus Oteo Iglesias, Petra J. Edquist, Sara Droz, Maurine A. Leverstein - van Hall, Xander Huijsdens

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    256 Citations (Scopus)


    The emergence and global spread of carbapenemaseproducing Enterobacteriaceae is of great concern to health services worldwide. These bacteria are often resistant to all beta-lactam antibiotics and frequently co-resistant to most other antibiotics, leaving very few treatment options. The epidemiology is compounded by the diversity of carbapenem-hydrolysing enzymes and the ability of their genes to spread between different bacterial species. Difficulties are also encountered by laboratories when trying to detect carbapenemase production during routine diagnostic procedures due to an often heterogeneous expression of resistance. Some of the resistance genes are associated with successful clonal lineages which have a selective advantage in those hospitals where antimicrobial use is high and opportunities for transmission exist; others are more often associated with transmissible plasmids. A genetically distinct strain of Klebsiella pneumoniae sequence type (ST) 258 harbouring the K. pneumoniae carbapenemases (KPC) has been causing epidemics of national and international proportions. It follows the pathways of patient referrals, causing hospital outbreaks along the way. Simultaneously, diverse strains harbouring New Delhi metallo-beta-lactamase (NDM-1) are repeatedly being imported into Europe, commonly via patients with prior medical exposure in the Indian subcontinent. Since the nature and scale of carbapenem-non-susceptible Entrobacteriaceae as a threat to hospital patients in Europe remains unclear, a consultation of experts from 31 countries set out to identify the gaps in diagnostic and response capacity, to index the magnitude of carbapenem-non-susceptibility across Europe using a novel five-level staging system, and to provide elements of a strategy to combat this public health issue in a concerted manner.

    Original languageEnglish
    Issue number46
    Publication statusPublished - 18 Nov 2010

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